LATIN AMERICA: Prevention Is Weakest Link in AIDS Fight

SANTIAGO, Jul 22 2010 (IPS) - Many Latin American countries have made strides in legislation and policies that promote sex education and health services for young people, which are essential for fighting AIDS. But implementation has been slow and often faces opposition, warn experts. With the XVIII International AIDS Conference under way in Vienna (Jul. 18-23), IPS tracked the level of compliance with the declaration “Prevent with education,” the commitment signed by Latin American and Caribbean health ministers at the previous AIDS Conference, held in Mexico in 2008.

The latest report from UNAIDS (Joint United Nations Programme on HIV/AIDS) states that some 33.4 million people are living with this disease worldwide — two million in Latin America and the Caribbean. The highest prevalence in the region is in Brazil and Mexico, with unprotected sex the primary form of transmission.

The region has relatively high availability of antiretroviral treatment for those carrying the virus, but one of biggest challenges is prevention of transmission, using evidence-based strategies that focus on the vulnerable populations: men who have sex with men, sex workers, and intravenous drug users, among others.

The principal goals of the Latin American and Caribbean ministerial declaration, with a deadline of 2015 and based on 2008 figures, include a 75- percent reduction in the number of schools lacking comprehensive sex education, and a 50-percent cut in the number of young people without access to sexual and reproductive health services.

In that context, UNESCO (UN Educational, Scientific and Cultural Organisation) is working on the “International Guidelines for Sexuality Education.”

“There has been progress (in terms of the declaration), though not what we would have liked to see,” said Alexis Sorel, member of the Sexuality and Democracy Network (DEMYSEX), a Mexican non-governmental organisation that presented in Vienna a region-endorsed glossary of 100 concepts on sex education.

Among those advances, the regional director of the UN Population Fund (UNFPA) Marcela Suazo highlighted the cases of Colombia, where resources have been designated for education and health services, and Cuba, with “its important experience that demonstrates the ties between education and health policies.”

“Other countries, like Argentina and Brazil, have made progress in legislation for sexual and reproductive health, which ensure the incorporation of prevention and health promotion in education programmes,” Suazo told IPS. Similar efforts can be found in Guatemala and El Salvador, she added.

In Mexico City, governed by the leftist PRD (Democratic Revolution Party), for the 2010-2011 school year there will be a class on sexuality and gender education, which as also been approved by the Public Education Secretariat of the national government, led by the conservative National Action Party.

Mexico’s National Public Health Secretariat has distributed a booklet to adolescents with information on contraceptive methods. Sorel said, however, that some states have been slow to take any action.

In Brazil, there have been advances in the “structuring of national policies” for sex education in the schools, including information about sexually transmitted diseases and homophobic discrimination, through an alliance of the ministries of Health and Education, said Juan Carlos Raxach, project advisor of the Brazilian Interdisciplinary Association on AIDS (ABIA).

“But in practice it is difficult to ensure that all of the schools take on this commitment,” and change is slow, Raxach told IPS. There have been specific actions that proved successful, such as material on sexual education for distribution in the schools produced by ABIA itself.

In his view, outside the school environment, there is a lack of sex education actions specific to adolescents. Many believe young people are covered by general prevention campaigns, like those promoting condom use, but adolescents often do not identify with those messages, whether because of the vocabulary used or the spirit of the initiatives, Raxach said.

In Chile, Leonardo Arenas, coordinator of the recently created Sexual Education Programme, of the private Arcis University’s school of social work, made use of the Transparency and Public Information Access Law to consult the Ministry of Education about compliance with the pledges the country signed in Mexico.

In its response, to which IPS had access, the ministry stated that the declaration’s principles are “contained in the Ministry’s Policy on Sexuality Education” for 2005-2010. Arenas, however, said the only advance was the training of more than 5,000 teachers and professors.

Even though the issue has been incorporated into the curricular fabric, “that doesn’t necessarily translate into action in the schools,” given their educational autonomy, Arenas told IPS. The municipalities run the public schools, so it depends on the ideology of the mayor in power, he said.

“Since the signing of the declaration in Mexico, there has been little progress in sexual education,” agreed Claudia Dides, director of the gender and equality programme of the Latin American Faculty of Social Sciences (FLACSO). It has not gone beyond the “pilot plans” due to the matter of values, she told IPS.

In Chile, which has seen an increase in the transmission of sexually transmitted diseases among adolescents and where the teen pregnancy rate remains unchanged, what stands out is a 2009 law that establishes norms on information and provision of services for regulating fertility.

The law establishes, among other things, that secondary schools should include a sexual education programme. But the enactment of the legislation has been delayed due to the change in the national government in March.

In Central America, Guatemala has recorded some successes. On Jul. 9, the ministries of Health and Education signed an agreement — like the UNAIDS initiative, it is known as Prevent with Education — for institutional cooperation to fight HIV and AIDS, adolescent pregnancy and sexual violence.

“There has been progress. One of the most significant advances is the signing of that agreement, which demonstrates that the ministries are taking on their appropriate roles,” Mirna Montenegro, with the Reproductive Health Observatory, told IPS. Sexual education is expected to begin in the classrooms this year, she added.

In addition, the regulation framework was passed last year for the 2005 Family Planning Law, which orders the Ministry of Health, and other public and private institutions, to provide the population with the latest family planning methods.

In Argentina, despite its 2006 law that included the creation of a comprehensive national sexual education plan, an assessment by the government’s Foundation for Women’s Studies and Research (FEIM) found that it came up short.

Although the Ministry of Education developed the programme and its content, the provincial governments have not yet implemented the plan, “which is why the impact of the actions cannot yet be evaluated,” concluded FEIM.

“The advances have been few in Argentina. The lack of political will of the national government, and of most of the provincial governments, in addition to the heavy pressure from the conservative religious sectors, constitute the principal obstacle,” states the Foundation.